尼泊尔西部两家三级医院基于医院分娩的隐性成本
Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.
作者信息
Acharya Jeevan, Kaehler Nils, Marahatta Sujan Babu, Mishra Shiva Raj, Subedi Sudarshan, Adhikari Bipin
机构信息
La Grandee International College, Pokhara University, Pokhara, Nepal.
Sandefjord Helsepark, Skiringssalveien 20, Sandefjord, Norway.
出版信息
PLoS One. 2016 Jun 16;11(6):e0157746. doi: 10.1371/journal.pone.0157746. eCollection 2016.
INTRODUCTION
Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs.
METHODS
A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study.
RESULTS
The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs).
CONCLUSION
Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated with hidden costs. Hidden costs can be a critical factor for many poor and remote households who attend the hospital for delivery. Current remuneration (10-15 USD for normal delivery, 30 USD for complicated delivery and 70 USD for caesarean section delivery) for maternity incentive needs to account the hidden costs by increasing it to 250 USD for normal delivery and 350 USD for C-section. Decentralization of the obstetric care to remote and under-privileged population might reduce the economic burden of pregnant women and can facilitate their attendance at the health care centers.
引言
由于存在通常未计入医院成本的隐性成本，贫困家庭在医院分娩的花费很高。本研究的主要目的是估算医院分娩的隐性成本，并确定与隐性成本相关的因素。
方法
在尼泊尔博卡拉的马尼帕尔教学医院和西部地区医院，对384名产后母亲及其丈夫/户主进行了一项基于医院的横断面研究。在出院时，使用结构化问卷对每位受访者进行面对面访谈。隐性成本根据研究期间的市场价格率计算。
结果
顺产和剖宫产的总隐性成本分别为243.4美元和321.6美元。在产妇护理总支出中；食品和饮料（53.07%）、衣物（9.8%）和交通（7.3%）的平均支出较高。对于有丈夫或户主陪同的产后妇女，顺产和剖宫产“误工天数”的总平均机会成本分别为84.1美元和81.9美元。识字的母亲（p = 0.007）、有工作的户主（p = 0.011）、家庭月收入超过25,000尼泊尔卢比（p = 0.014）、私立医院作为分娩地点（p = 0.0001）、剖宫产作为分娩方式（p = 0.0001）、住院时间较长（>5天）（p = 0.0001）、家到医院的距离较远（>15公里）（p = 0.0001）以及家到医院的出行时间较长（>240分钟）（p = 0.007）等因素与较高的隐性成本（>25000尼泊尔卢比）显著相关。
结论
发现医院分娩的隐性成本以及误工天数的机会成本很高。一些社会人口因素、与分娩相关的因素（分娩地点和方式、住院时间、距医院的距离和出行时间）与隐性成本相关。隐性成本对于许多前往医院分娩的贫困和偏远家庭可能是一个关键因素。目前的产妇激励报酬（顺产10 - 15美元、复杂分娩30美元、剖宫产70美元）需要考虑隐性成本，将顺产的报酬提高到250美元，剖宫产提高到350美元。将产科护理分散到偏远和贫困人群可能会减轻孕妇的经济负担，并促进她们前往医疗保健中心就诊。
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